Healthcare Provider Details

I. General information

NPI: 1598115974
Provider Name (Legal Business Name): KASSIE J. COSGROVE FNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: KASSIE J. COSGROVE FNP-BC

II. Dates (important events)

Enumeration Date: 06/16/2016
Last Update Date: 01/12/2026
Certification Date: 01/12/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

314 GOFF MOUNTAIN RD SUITE 3
CROSS LANES WV
25313-6602
US

IV. Provider business mailing address

314 GOFF MOUNTAIN RD STE 3
CHARLESTON WV
25313-6600
US

V. Phone/Fax

Practice location:
  • Phone: 304-388-7080
  • Fax: 304-388-7090
Mailing address:
  • Phone: 304-388-7070
  • Fax: 304-388-7090

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number83534
License Number StateWV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: